title: Laparoscopic or laparoscopic-assisted pelvic surgery in small infants: our experience.
abstract: OBJECTIVE
  The objective of this study was to review our experience of laparoscopic (LA) or laparoscopic-assisted pelvic surgery (LAPS) in small infants.
  
  
  METHODS
  The medical records of 35 patients who underwent an LA or LAPS between January 2007 and June 2010 were studied and 21 patients who were younger than 1 year or whose weight was less than 10  kg were included. Indications, procedures, results, and complications were analyzed.
  
  
  RESULTS
  The indications of surgery and procedures done were impalpable undescended testes (7 cases--3 single-stage orchidopexy and 4 Fowler Stephen stage I ligation of testicular vessels), Hirschsprung's disease (HD; 5 cases--all laparoscopic-assisted transanal pull-through), anorectal malformation (ARM; 3 cases--all laparoscopic-assisted pull-through), disorders of sexual differentiation (3 cases--1 herniotomy and 2 gonadal biopsy), sacrococcygeal teratoma (1 case--laparoscopic mobilization of pelvic component and posterior sagittal excision), and ovarian mass (2 cases; laparoscopic oophorectomy). There were 14 males, 4 females, and 3 of indeterminate sex. All procedures could be successfully completed without conversion. There was no anesthesia-related complication or need for postoperative ventilatory support. There were no immediate procedure-related complications. One female child with ARM had rectal mucosal prolapse; 1 HD case had rectovaginal fistula that healed following fecal diversion. The major advantages of laparoscopy in different indications were magnified access into the depth of pelvis and early frozen section biopsies in HD, accurate placement of neoanus in the center of muscle complex in ARM, early ligation of vessels and avoidance of laparotomy in sacrococcygeal teratoma, ease of decision making and better mobilization of vessels in undescended testes, and diagnostic accuracy and therapeutic procedure in ambiguous genitalia.
  
  
  CONCLUSIONS
  Laparoscopic pelvic surgery in small infants is a safe procedure with advantage of magnification, access, and cosmesis.
authors.affiliation: Department of Pediatric Surgery, Maulana Azad Medical Collage and Lok Nayak Hospital, New Delhi, India. satish.childurology@gmail.com
authors.forename: Satish Kumar
authors.initials: SK
authors.lastname: Aggarwal
authors.forename: Shandip Kumar
authors.initials: SK
authors.lastname: Sinha
authors.forename: Simmi K
authors.initials: SK
authors.lastname: Ratan
authors.forename: Anjan
authors.initials: A
authors.lastname: Dhua
authors.forename: Nitin
authors.initials: N
authors.lastname: Pant
authors.forename: Nitin
authors.initials: N
authors.lastname: Borkar
authors.forename: Gaurav
authors.initials: G
authors.lastname: Nirwal
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D010388:Pelvis / Q000601:surgery*